Mechanical Ventilation Training Curriculum for Pulmonary Critical Care Fellows during the COVID-19 Pandemic

Aryan Shiari; Divya Venkat; Abdelaziz Mohamed; Sarah J Lee; Abdulghani Sankari

doi:10.34197/ats-scholar.2022-0048IN

Mechanical Ventilation Training Curriculum for Pulmonary Critical Care Fellows during the COVID-19 Pandemic

ATS Sch. 2023 Jul 27;4(3):362-371. doi: 10.34197/ats-scholar.2022-0048IN. eCollection 2023 Sep.

Authors

Aryan Shiari^{1

2

3

4}, Divya Venkat^{3

4

5}, Abdelaziz Mohamed⁶, Sarah J Lee⁷, Abdulghani Sankari^{3

4

5

8}

Affiliations

¹ Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin.
² Mayo Clinic Alix School of Medicine, Rochester, Minnesota.
³ Division of Pulmonary and Critical Care, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
⁴ Department of Medical Education and.
⁵ Division of Pulmonary and Critical Care, John D. Dingell VA Medical Center, Detroit, Michigan.
⁶ Respiratory Institute, Cleveland Clinic Akron General Hospital, Akron, Ohio.
⁷ Respiratory Institute, Cleveland Clinic Main Campus, Cleveland, Ohio; and.
⁸ Department of Medical Education, Ascension Providence Hospital, Southfield, Michigan.

Abstract

Background: Mechanical ventilation (MV) management is an essential skill for pulmonary and critical care medicine (PCCM) fellows to master during training. The unprecedented emergence of the coronavirus disease (COVID-19) pandemic highlighted the need for advanced operator competency in MV to improve patients' outcomes.

Objective: We aimed to create a standardized case-based curriculum using a blended approach of high-fidelity simulation, rapid-cycle deliberate practice, video didactics, and hands-on small group sessions for rapid accumulation of knowledge and hands-on skills for PCCM fellows before caring for critically ill patients during the COVID-19 pandemic.

Methods: The MV curriculum consisted of the following steps: 1) baseline written knowledge test with 15 multiple-choice questions covering MV, the latest evidence-based practices, and pathophysiology of COVID-19; 2) baseline confidence survey using a 5-point Likert scale; 3) a one-on-one session using a high-fidelity simulation manikin, a lung simulator, and a mechanical ventilator to test baseline competencies; 4) a structured debriefing tailored per fellow's 50-point competency assessment checklist from the simulation using rapid-cycle deliberate practice; 5) video didactics; 6) a hands-on session in small groups for basic knobology, waveforms, and modes of MV; 7) a one-on-one simulation reassessment session; 8) a written knowledge posttest; and 9) a post-training confidence survey using a 5-point Likert scale.

Results: Eight PCCM fellows completed the training. The mean multiple-choice question score increased from 7.4 ± 2.9 to 10.4 ± 2.4 (P < 0.05), and the simulation scores increased from 17.1 ± 4.4 to 30.8 ± 3.7 (P < 0.05). Comparing the simulation reassessment to the baseline, fellows showed significant improvement (P < 0.05) in assessing indications for MV; implementing rapid sequence intubation for patients with COVID-19; initiating MV and ventilator bundle per best practices; recognizing and managing mucous plugging, ventilator dyssynchrony, and evidence-based treatments for acute respiratory distress syndrome; and developing a care plan for proning. The post-training survey revealed improved learner confidence in all competencies.

Conclusion: This pilot MV curriculum using a blended approach was feasible and allowed PCCM fellows to significantly improve their knowledge and hands-on skills, allowing for the appropriate use of MV during the pandemic. Self-reported improvement scores further reinforced this. The emergent need for novice learners may again be necessary for future pandemic settings where standard training models requiring extensive training time are limited.

Keywords: mechanical ventilation training; medical education; rapid cycle deliberate practice.